摘要
目的探讨采用自制单孔腹腔镜通道行经脐单孔腹腔镜下根治性肾切除术的安全性和初期疗效。方法2010年7月至2011年11月肾细胞癌患者11例，男5例，女6例。年龄37～68岁，平均49岁。体质指数（bodymassindex，BMI）18．4～30．4kg／m2，平均24．2kg／m2。腹部B超及肾脏CT检查提示11例均为肾细胞癌，肿瘤位于左肾7，右。肾4例；位于肾上极3例、中部4例、下极4例；2例可疑淋巴结转移，1例患肾并存肾囊肿，未见其他腹部脏器转移征象。肿瘤临床分期：T1aN0M01例，T1bN0M05例，T2aN0M03例，T。N，M。2例。全麻下行经脐单孔腹腔镜下根治性肾切除术，采用自制单孔腹腔镜通道，手术步骤与传统腹腔镜下肾根治性切除术相似。结果本组11例手术中8例顺利完成，2例中转为传统腹腔镜手术，1例中转为手助腹腔镜手术，无中转开放手术。手术时间155—297rain，平均225rain。术中出血量50—900ml，平均271m1。术后病理诊断均为肾细胞癌，病理分期为T1a3例，T，。5例，T2a3例。术后视觉模拟疼痛评分3～6分，平均4分。住院时间5～15d，平均10d。术后随访8～24个月，平均17个月，11例患者均存活，对切口外观满意，无肿瘤复发及转移。结论采用自制单孔通道行经脐单孔腹腔镜下根治性肾切除术对部分肾细胞癌患者是一种安全的治疗方式，切口美观性好，初期肿瘤学效果满意。
Objective To evaluate the safety and primary outcomes of transumbilical laparoendo- scopic single-site radical nephreetomy （LESS-RN） by using home-made single-port device. Methods From July 2010 to November 2011 , we had performed transumbilical LESS-RN on eleven renal cell carcino- ma patients by using the home-made single-port device. There were 5 males and 6 females in this group. The mean age was 49 （37 -68） years and mean body mass index was 24.2 （18.4 -30.4） kg/m2. Ultrasound and CT scan revealed 11 renal tumors （7 on left and 4 on right） , with 3 on the upper pole, 4 in the middle and 4 in the lower pole. There were 2 cases with suspicious lymph node metastasis and one case with renal cyst. There was no distant metastasis. The intracorporal procedure was similar to conventional laparoscopic radical nephrectomy. Results Except two cases converted to conventional laparoscopic RN and one ease converted to hand-assisted laparoscopic RN, the other procedures were completed successfully without open conversion. The mean operative time was 225 min （155 -297 rain） and mean estimated blood loss was 271 ml （50 -900 ml）. Postoperative results showed that all cases were renal cell carcinoma and there were 3 ca- ses in Tla, 5 cases in Tlb and 3 cases in T2a. The mean visual analog pain scale （VAPS） was 4 （3 -6） , and mean hospital stay was 10 d （5 -15 d）. With the mean follow-up of 17 months （8 -24 months） , all patients were alive with no evidence of local recurrence or metastasis. Patients were satisfied with the cosmet- ic results of the wound recovery. Conclusions Transumbilical LESS-RN using home-made single-port de- vice is a safe approach in selected patients and has excellent cosmetic results. Primary oneologic outcomes are good. However, we will still need large clinic trials to further evaluate the efficacy and safety of LESS-RN.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2012年第10期739-743,共5页
Chinese Journal of Urology
关键词
肾细胞癌
单孔腹腔镜
肾切除
手术技术
初期疗效
.
Renal cell carcinoma
Laparoendoscopic single-site surgery
Nephrectomy
Sur-gical technique
